11 Investigates Code Blue: Violence in Healthcare

From physical and verbal attacks by patients to a deadly hostage situation at a Pennsylvania hospital earlier this year, healthcare workers are reporting alarming levels of violence on the job.

The encounters are leaving local healthcare workers physically injured and emotionally exhausted and causing some to leave the profession altogether. In Code Blue: Violence in Healthcare, 11 Investigates is detailing recent attacks, the permanent injuries they’re causing and the plea for lawmakers to intervene.

“Good job. Nice and easy,” a therapist tells Donna Ruhl. “Just relax.”

It’s her second vision therapy session. She has months of therapy still to go, part of the process of correcting double vision she has been experiencing since January, when she suffered a traumatic brain injury after hitting her head off the hospital floor.

Donna and her husband, Richard Ruhl, were working in the same behavioral health unit at Penn Highlands Mon Valley in Washington County.

“All of a sudden, I just heard slamming. And I looked out, and he was slamming the phone against the receiver,” Donna Ruhl said.

He is Luke Bienia, a patient who is now facing criminal charges for what the Ruhls and police say happened next.

They say Bienia started shouting expletives at Donna when she told him to stop, and Richard stepped in to calm Bienia down.

“He threw his hands up and was like ‘what are you gonna do about it, huh?’ And he came at me and swung,” Richard Ruhl said.

Police records allege Bienia punched Richard four of five times and was wrapping his hands around Richard’s neck when Donna grabbed the patient from behind to try to stop the attack.

“He lunged back, which is when I struck the floor with my head,” Donna Ruhl described. “And when I woke up, Richard was on my left side, lying on the ground with him on top, just punching him in the face over and over and over again.”

Richard Ruhl was unaware that his wife was knocked unconscious and somewhat relieved that Bienia’s attention was focused on him. He said he was also aware that he could only take so many more blows to the head.

“Either I’m going to die or he’s free to get up and hurt other people,” Richard Ruhl said.

That’s when two other patients ran to the Ruhls’ aid, helping hold Bienia down as they waited for security. They say Bienia continued threatening them even after police arrived, telling them it wouldn’t be difficult to find them outside of work.

Richard was seen in the emergency room that night, has mostly recovered from his injuries and has started a new job as an ICU nurse with a different health system. Donna has not returned to work, and it could be many months until she does.

It wasn’t until after the attack that the Ruhls say they learned Bienia had been violent in the emergency room prior to being admitted to the unit, throwing a table and threatening emergency room staff.

“It’s been rough. It’s been hard. I would say very emotional,” Richard Ruhl said, speaking about the toll the attack has had on the couple and their three teenagers. “I was there when it happened, and I’m supposed to protect her.”

Dr. Jeffrey Begg is Donna’s optometrist a Willowbrook Eye Care Associates. He says her eyes and brain are not in sync with each other, and she will likely need four to six months of therapy, if not more.

“She’s having to think to see, essentially, so she’s putting forth a lot more effort than anybody needs to for normal day-to-day function,” Begg explained.

Donna is not the only healthcare patient he’s seen for vision therapy after they were injured by one of their patients.

“Probably 5 to 10, actually, at any given point of time here over the last couple years. It’s become something that we’ve been seeing more of,” Begg said.

In our local counties, 11 Investigates has confirmed at least 10 assaults on local healthcare workers in recent months that were so severe that criminal charges were filed. Several district attorneys and police departments have yet to respond to our inquiries, so it’s likely that number is much higher.

Just a few hours away at UPMC Memorial Hospital in York, violence against healthcare workers turned deadly. An armed man entered the hospital, made his way to the intensive care unit and held several staff members hostage. One nurse said the gunman held a gun to her head and pulled the trigger three times but was out of ammunition. Several staff members were shot before police shot and killed the suspect. A young police officer with ties to western Pennsylvania was shot and killed.

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UPMC said it has made several security changes to its facilities since the shooting. A spokesperson released a full statement to 11 Investigates that you can find at the end of this story.

“Why can’t we make changes ahead of time? Why can’t we be proactive and not reactive?” said Tammy May. She is president of the PASNAP union of registered nurses at Butler Memorial Hospital.

The union is in the middle of contract negotiations with Independence Health System, which runs the hospital. Late March, nurses picketed outside the facility, advocating for safer worker conditions. It came after multiple nurses were physically assaulted by patients in separate incidents, leading to criminal charges against several of them.

“For whatever reason, violence has escalated. And it’s not just the patients. It’s their families,” May said. “It’s not just the physical assault all the time. It’s the verbal abuse.”

A report released in February by National Nurses United, a national union of registered nurses, found that eight in ten nurses have experienced workplace violence in the past year, ranging from verbal threats to physical abuse.

Locally, some health systems are increasing self-defense training offerings and adding armed police officers. Changes like those are costly, and some health systems have admitted they are dealing with financial challenges post-pandemic.

The violence issue is forcing some healthcare workers out. Donna Ruhl was set to graduate next year from a nurse practitioner program. She has not been able to continue her education since she was injured.

“This may be the end of a seven-year journey. And that’s probably the hardest thing to swallow right now,” she said.

Due to the trauma she is dealing with, she does not know if she will ever be able to work in a hospital setting again. Dr. Begg said her vision may never fully recover.

Her employer, Penn Highlands Healthcare, declined an interview and did not answer if Penn Highlands Mon Valley has made any changes since the Ruhls were attacked. A spokesperson released the following statement.

“Hospitals are healing places that sometimes experience unpredictable situations. The many different emotions occurring can sometimes manifest in aggression towards hospital staff. At Penn Highlands Healthcare, we do not tolerate physical or verbal aggression or abuse towards staff, patients or visitors. As a health system, we have policies and procedures in place for the safety and security of our patients, employees and visitors while ensuring top-quality patient care. To promote healthcare safety at our hospitals and facilities, we provide ongoing staff education including drills to update staff on all types of safety protocols and best practices. To help secure our facilities, measures range from having trained staff and security guards to limiting access to our facilities during certain hours to video monitoring. We collaborate with local police and continuously evaluate how we can enhance safety and security across our health system to preempt or mitigate situations as they arise.”

The Ruhls said there were no cameras in the area where they were attacked, and there were no security guards on the floor at the time.

Pinpointing a cause of the violence healthcare workers are experiencing is difficult. Many healthcare workers and union leaders say they have noticed an uptick since the pandemic. Some point to staffing levels. Others say a lack of investment in security is responsible. Others say people are more demanding and less patient with their medical providers. Many say it is a combination of factors.

If you are a healthcare worker and have been impacted by violence, let the 11 Investigates team know. You can email 11investigates@wpxi.com or leave a message on our tip line at 412-237-4911.

“UPMC is steadfast in our commitment to the safety and well-being of all at our facilities. Health care has long been built on accessibility with openness to caring and healing for all. But sadly, the world has changed. We are thoughtfully enhancing the safety of everyone who walks through our doors by reinforcing already existing strong security measures and deploying heightened standards across UPMC.

“UPMC staff are devoted to caring for others and we expect them to be treated with courtesy and respect by patients and visitors. Code of conduct and disruptive behavior policies are enforced to uphold the safety of our care teams and the safe operation of our facilities.

“We have many strict security measures already in place and are adding more. Patients and visitors may notice some changes as they enter UPMC facilities, such as:

• Some entrances that were once open to everyone will now only be accessible to employees with a UPMC ID badge. Employees are not permitted to hold doors open for non-employees at these entrances.
• Those who need to enter a hospital in the late evening and overnight will need to enter through the Emergency Department.
• Metal detectors will be installed in additional Emergency Department entrances to enhance 24-7 security screening.
• At some hospitals, visitors and patients will enter through a high-volume traffic screening system, which uses advanced technology for weapons detection.
• We will implement a standardized visitor management program, which means visitors will have to check-in at main entrances and provide identification and reason for visiting.

“UPMC employs more than 250 armed police officers and another 600 security personnel across the organization to provide support to all who enter our facilities.

“We are additionally working to ensure communication with our internal and external law enforcement partners is as easy and fast as possible in the event of any issue that raises alarm; and we are further enhancing our robust emergency preparedness education and training programs for staff.”

The day of the picketing outside Butler Memorial Hospital, Independence Health released a statement about its contract negotiations with the PASNAP union of registered nurses the read in part:

“The safety and security of our patients, staff and visitors are our highest priorities. We are deeply committed to maintaining an environment where everyone feels safe and valued and welcome input from PASNAP and all employees. While we do not disclose specific details about our advanced security protocols, we continuously monitor, review, and enhance our security measures, as well as foster a culture of preparedness and collaboration with our staff, on-site security, and local authorities. Our goal is that all our facilities remain secure and welcoming places for everyone who walks through our doors.

Like so many hospitals throughout the country, BMH has been forced to grapple with safety and financial challenges in the post-COVID era and we have asked PASNAP to partner with us on these priorities as we write the next chapter in our turn-around story.”

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